A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Thursday, March 08, 2007

The Hatchling

I have a medical student in my office this week.

He actually shadowed me for a week as a high school student five years ago, went off to college where he played Division 1 football for four years, somehow ended up in medical school instead of the NFL* and is now doing his first year primary care preceptorship with me.

*(I'm not 100% sure why. I believe it's because he's always wanted to be a doctor -- something he and I have in common -- and that he wasn't quite big enough. Then again, he does have a specific special teams skill that he probably could have parlayed into a respectable NFL career. I'll have to ask him.)

He is a joy. He's as knowledgeable and self-assured as anyone can be who is acutely aware that he doesn't know squat. His med school thoughtfully sent a packet of information (to me; apparently they didn't send him anything) about what he was supposed to accomplish in his time with me, so I'll make sure he gets to see a patient he can write a SOAP note on. We went over "taking vital signs correctly on patients of various ages and sizes;" yesterday he discovered the joys of measuring a wriggly toddler. I've been trying to teach as well as I can, but when they're not even all the way through the first year of med school, the balance between throwing out way too much info just totally over their heads and being obnoxiously elementary ("slip that probe into one of those plastic covers until it clicks and tell the patient to hold it under her tongue until it beeps") is tougher to negotiate than one might think.

Yesterday we had a snowstorm. Sort of. One to four inches called for, starting in the morning but going on through the day. No school cancellations. Hatchling called me at 6:30 as agreed upon, and we concurred that it was going to be a bust and we were going to have a regular day. My staff felt otherwise, though. They didn't want to struggle through traffic (always a sore spot in my poorly overdeveloped neck of the woods) only to have the weather worsen, the patients all cancel, and then have to try and make their way back home over treacherous roads. They bailed.

I got to the office just fine, as my commute is against traffic. Hatchling made it about forty-five minutes later, mainly because the color white makes drivers around here psychotic. I asked him if he was willing to be thrown into the deep end of a completely different pool than he'd bargained for, and he was a trooper. I gave him about five minutes of training: what information he needed to get for referrals, prescription refills and appointments. How to answer a question with a question. (The answer to "Is the doctor there?" is "Can I help you with something?" One of my staffers had a terrible time trying to learn she didn't have to say "yes" and then try to come up with an excuse why she couldn't just get me on the phone.) And so the Hatchling spent the day answering the phones while I saw patients. He saw some with me, but when the phone rang, he knew it was his job to go get it. He was awesome.

None of the patients cancelled. We even added three appointments, including a new patient.

In addition to fielding phone calls, he learned to call in prescriptions, use the fax machine, how my filing system works and how I like to schedule appointments (not nearly as straightforward as one might think.) What he gets credit for is not copping an attitude about performing tasks that someone more small-minded might think of as "beneath him." Actually, since one of the objectives listed for me as a preceptor is to "model the attitudes and skills of a primary care physician," (in this case, also those of solo practitioner/small business owner) I think I did a pretty good job of showing him that *nothing* is "beneath me." We traded off tasks like filing, packaging blood samples for the lab and straightening up exam rooms. It was beneath scut. But it had to get done, and he pitched right in. We ended up having a regular day after all, and I couldn't have done it without him. Thank you, Hatchling.

I wish I could be a fly on the barroom wall to hear him regale his buddies with his preceptorship experiences over a beer next week.

Sounds like he has the makings of a great physician. Flexibility and thinking on your feet are skills that are never wasted. Learning how a primary care office works when the staff bails and the patients don't -- priceless.

I know you mean well, but this is what gives FP such a bad rep among US grads these days. We got sent off on these things as lil M1s and it was right then I decided not to do FP - with my FP preceptor (wonderful gent) we got to lecture obese people on losing weight and fill out physical exams. With my cards preceptor I got to help on caths, with my surgery preceptor I got to close and with my FP preceptor I got to fill out workers comp forms. You've got to sell your specialty! Show the good sides.

#1- this was a truly wonderful post. I comepltely disagree with anonymous up there. The way a practice runs affects patient care. It;s not paerwork, it's chest x-rays and eks, and lab reports. It's not phone calls, it's Patients calling. It's not appointment scheduling - it's triage. Until you see the day to day workings of an office as patient care, you'll never get it.If we never learn it, we'll never know when it's not being done right, and in the end, the care we provide will be inferior because if that.

I think it's very important to know all the workings of an office. This young man has proven (as someone said earlier) that he's flexible and can think on his feet. And, I get the impression he's a pleasant person. These are very important traits for anyone in health care.

TBTAM: Of course it's important to know how to do that stuff if you're actually going into FP. If you're going into cards or surgery you're not going to be sitting around tracking down appointments. I'm not going into FP so it's no skin off my back, but the appearance that FP is mostly drudgery is why my class of 150 or so is sending like 5 people to FP (and they were mostly at the bottom of the class), something that causes all the FP profs here visible angst as they try to convince us FP is a noble job. Just sayin'.

Anon: I have no idea what the Hatchling is going into. He's required to do a first-year Primary Care preceptorship, which is what his week with me was. Obviously with his credentials, an ortho/sports medicine residency is his to decline. As far as going into FP, that's more of a political than a substantive issue that you contribute to with your stereotypes. A cardiologist who can't run his office without his staff for a day in a pinch will just lose a whole day's revenue. Running an office is a useful skill no matter what your specialty. Just sayin'.

Don't even worry about this! Any med student who is not a total asshole shouldn't mind this. We always cause extra work and teaching slows down clinic docs, so I feel a lot better if I can help, even if it is with "dumb" stuff. And that's probably educational too. He'll learn important stuff about billing, pharmacy, and patient relations.